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Small business mental health diagnosis and claims process

Mental health can be an overlooked part of our overall health. Mental health conditions may not always come with physical symptoms that we may experience if we were suffering from poor physical health, such as pain or physical illness. However, it’s just as important to look after our mental health as it is to look after our physical health. 

Mental health conditions (specifically stress, depression and anxiety) accounted for the majority of working days lost due to work-related ill health in 2021/22, with a total of 17 million days lost.1 One survey found that 80% of small business owners reported experiencing symptoms of poor mental health. Despite this, 44% of small business owners have never accessed mental health support, with just one in four (25%) having accessed professional help.2

In this guide, we look at some of the frequently asked questions around our mental health diagnosis and claims process for small business owners and their employees.

What is a mental health condition?

When you are experiencing poor mental health, you might find that you think, feel or behave differently to when you are in a period of good mental health. You might find these feelings difficult to cope with, which can be just as debilitating as when you are suffering from poor physical health.

There are lots of different types of mental health conditions. Some mental health conditions have similar symptoms to others, and some people may experience different symptoms of the same condition. 

See below for some examples of mental health conditions:

Most people will feel temporarily low at some point in their lives. However, when someone has a constant feeling of sadness, this may indicate that they are experiencing depression. People living with depression often experience intense feelings of guilt, low self-esteem, poor energy and concentration, all of which can have a severe impact on day-to-day life.

Everyone that lives with depression can experience a different combination of symptoms. Some of these symptoms may include:

  • Consistently feeling low
  • Easily agitated and/or irritated
  • Detachment from others
  • Lack of energy
  • Sleeping or eating much more or less than usual
  • Lack of confidence or self-esteem
  • No interest in usual hobbies
  • Crying regularly

Just like there are many different symptoms, there are also many different types of depression. These include:

  • Mild depression
  • Clinical depression
  • Post-natal depression
  • Seasonal affective disorder (SAD)
  • Bi-polar disorder

You can read more about depression in our blog post here.

We all have feelings of worry and nervousness in our day to day lives. However, when that worry becomes excessive, then an anxiety disorder might be diagnosed. Anxiety could prevent you from leaving the house or doing the activities that you once enjoyed, and can turn into an intense feeling of fear, so it’s very different to having occasional feelings of worry and nervousness.

Symptoms of anxiety can be very different for different people. According to the NHS, symptoms of general anxiety disorder can include3:

  • Feeling restless or on edge
  • Being irritable
  • Getting tired easily
  • Having difficulty concentrating or feeling your mind goes blank
  • Having difficulty getting to sleep or staying asleep
  • Having tense muscles

As well as general anxiety disorder, there are also many different types of anxiety disorder, these include:

  • Panic disorder
  • Phobias
  • Obsessive compulsive disorder
  • Post-traumatic stress disorder

You can read more of our articles on anxiety here.

Stress is very common and is our body’s response to feelings of pressure or threat. It can be triggered by a number of things, from your job, money to your friends and family. If you experience high levels of stress over a prolonged period of time, it could lead to mental and physical exhaustion. Chronic unmanaged workplace stress over a long period of time can also lead to burnout.

Stress can have a number of mental and physical symptoms, including3:

  • Headaches or dizziness 
  • Muscle tension or pain
  • Stomach problems
  • Difficulty concentrating
  • Feeling overwhelmed
  • Struggling to make decisions
  • Being forgetful
  • Being irritable 
  • Sleeping too much or too little

You can read more of our articles on stress here.

Does AXA Health cover pre-existing mental health conditions?

Private health insurance generally only pays for treatment of medical conditions that you become aware of after you join. Whether you’re covered for a medical condition that you have previously experienced will depend on the underwriting option that you choose when you take out your plan with us. 

With our Mental Health option, our underwriting options include:

Full medical underwriting: 

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. Before you claim, we will need to check that your claim isn’t for a pre-existing condition or some specified conditions.


With the moratorium underwriting option, you won’t have cover for treatment of medical problems you had in the five years before you joined us, until:

  • you’ve been a member for two years in a row, and
  • you’ve had a period of 12 consecutive months since you joined that have been trouble-free from that condition

Trouble-free means that for your medical condition you haven’t:

  • had a medical opinion from a medical practitioner, including a GP or a specialist
  • taken medication (including over the counter drugs)
  • followed a special diet
  • had medical treatment, or
  • visited a practitioner, therapist, acupuncturist, optician or dentist 

Continuing medical exclusions:

If you’ve joined AXA Health on these terms from another provider, it means we’re carrying on the underwriting you had with them for your medical conditions. Any special terms or exclusions will be on your membership certificate. You may be able to claim for pre-existing conditions, subject to the plan and cover options included in your new plan with us. For groups of 1 or 2 people, there may be additional terms that need to be added to your plan.

Medical history disregarded:

This underwriting option means that we accept any pre-existing conditions you may have had when you joined us, so you don’t need to worry about any underwriting exclusions. Your cover will be in line with the terms of your new plan with us. This option is available if you're looking to cover 15 employees or more.

If you include our Employee Assistance Programme Premier^ with your plan, you and your team will be able to access up to 8 sessions of face-to-face counselling if deemed necessary, regardless of your previous medical history and the underwriting option on your plan. Find out more about EAP Premier.

^EAP Premier isn’t available on its own, without other cover options included on your plan.

What is involved in the mental health diagnosis and assessment process for AXA Health small business health insurance members?

We understand that it can sometimes be difficult to reach out for help when you are experiencing poor mental health. That’s why we want to detail what happens when you or a member of your team contacts us for support, so you know what to expect and what will happen. The below process applies when you have the Mental Health option as part of your plan (cover is subject to previous medical history).

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Step 1

Your team member calls our claims team on the number shown in their handbook. 

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Step 2

They will then speak to one of our Personal Advisors, who will ask them about their symptoms. They may also ask about their previous medical history in relation to what they are experiencing, in order to determine whether they are eligible through their plan. 

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Step 3

The Personal Advisor will ask your employee if they have received a GP referral already. If they haven’t they will be told about our mental health pathway, which doesn’t require a GP referral in order to get an assessment with a mental health practitioner (available to members aged 18 and over).

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Step 4

If your employee would like to go ahead with an assessment, the Personal Advisor will then arrange for them to be booked in for a telephone assessment either with us or with one of our trusted third-party providers.

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Step 5

Your employee will then have a telephone assessment with a mental health practitioner which will last up to 30 minutes. They will ask about symptoms in order to recommend the best course of treatment.

What happens after the mental health assessment?

Following their assessment, the mental health practitioner will recommend the best treatment option for your team member. Either ourselves or one of our trusted third-party providers will then arrange their treatment with a clinician.

We understand that your employee will want to start feeling like themselves again as soon as possible. That’s why we aim for them to start their treatment as quickly as possible after their telephone assessment. How quickly they can start receiving their treatment may depend on whether they would prefer to have online or face to face treatment.

What if my employee already has a GP referral?

If your employee has already received a mental health referral from their GP, they won’t need to have an assessment through our mental health pathway. They will need to call the claims number shown in their handbook in order to speak to one of our Personal Advisors. The Personal Advisor will check the eligibility of their claim and will ask what treatment the GP has referred them for.

Our Personal Advisor will then be able to arrange for our specialist appointment booking service to source a specialist, they will provide details to the member of practitioners to enable them to arrange their treatment.

What happens if I still experience symptoms after finishing my treatment?

If your employee is still experiencing symptoms once their treatment has ended, or their symptoms come back, they can call our claims team again on the number shown in their handbook. One of our Personal Advisors will then be able to organise another telephone assessment for them with a mental health practitioner.

As with many health insurance policies, long-term/ongoing treatment for chronic conditions isn’t covered on your plan.

How do I claim/pay for treatment?

The treatment provider will bill AXA Health directly for all treatment.

If your employee has an excess on their plan, they need to pay this directly to the provider for treatment covered by the plan. If your employee has any monetary limits on their treatment, they may have to contribute to the cost of their treatment. We’ll talk to them about this when they contact us.

If counselling is recommended as the best treatment for you through our mental health pathway, this won’t affect their excess.

AXA Health small business health insurance mental health option

With our mental health option at AXA Health in place, you’ll show your business commitment to supporting mental health. And you’ll be able to help your staff start feeling like themselves again, whether they need counselling, cognitive behavioural therapy (CBT), or psychiatric treatment in a private hospital.

Our mental health option includes cover for:

  • Counselling sessions: face-to-face or remote counselling through our mental health pathway, helping your employees get the help they need faster
  • Outpatient treatment: specialist consultations for psychiatric treatment, or psychiatric treatment by psychologists and cognitive behavioural therapists
  • Care in hospital: private psychiatric treatment fees, including accommodation, diagnostic tests and drugs at any of the hospitals or day-patient units in our Directory of Hospitals

Find out more about our Mental Health option, including what we do and don’t cover, and get a quote today

Our Mental Health option is subject to medical history.

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.

Get access to the following offers and services as standard


24/7 online GP service

Access to video or phone appointments with a GP or Advanced Nurse Practitioner, for up to 20-minutes, means your employees can get treatment whenever and wherever they need it. AXA Doctor at Hand is powered by Doctor Care Anywhere. Appointments are subject to availability. Advanced Nurse Practitioners are available 8am-10pm.

Hospital bed

Care for cancer and heart conditions

Our experienced healthcare practioners are available at the end of the phone day or night. Speak to our specialist cancer and heart nurses 9am-5pm Monday – Friday. Outside these hours our experienced nurses and counsellors provide round the clock support by phone. 


Fast-track to a specialist

Your employees can see the right person quickly. The sooner they see a consultant, the sooner they can get a diagnosis and treatment, and the sooner they can start getting better. You'll need to include access to specialist consultations and diagnostic tests with your business healthcare plan for the consultation to be covered.

Easing the pressure

Easing the pressure with physio

Our muscles, bones and joints team are here to help your people manage or alleviate joint and muscle pain – whether it’s a bad back or sprained ankle. A physiotherapist or osteopath will assess their symptoms online or over the phone and talk to them about what they could mean. This service is available for members aged 18 and over.

Medical assistance

Health information and support

We’ll give your employees access to our 24/7 health support line. It comes as standard, no matter what cover options you choose. It takes away any niggling health worries, helping them feel their best and give their best.


Access to up to 40% off monthly gym membership

Access to up to 40% off monthly Nuffield Health, Fitness and Wellbeing centre membership and Hussle Monthly+ pass fees** for you and all your employees. Which means your team can find their motivation, whether they’re training for a marathon or just getting started.

Get a quote
Call us on 0800 389 7413*

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1HSE, 2022

2Mental Health UK


*Phone 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.

**Discount applies to Nuffield Health fitness and wellbeing centre monthly individual membership only. Your employees must provide proof of membership and/or employer. You, your spouse, partner or dependent must be a named member on a current AXA Health  healthcare plan to get a 40% discount and be 18 years or older. As a member, you can access your home club (the one you select on joining) as well as many more clubs around the country. These depend on your home club. You must use your home club at least 50% of the time. The joining fee is £39 and may be subject to change by Nuffield Health. Existing members of Nuffield Health who transfer to a 40% off AXA Health discount will be charged a £39 administration fee by Nuffield Health. Read full terms and conditions at axahealth.co.uk/terms/gym-discount.

40% off Nuffield Health 24/7 online memberships - available to your employees and their spouses, with or without an AXA Health membership. Read full terms and conditions at axahealth.co.uk/terms/gym-discount.

40% off the purchase of a Hussle Monthly+ pass is available to members on an AXA Health healthcare plan. A partner or spouse and direct dependants included on their healthcare plan can also get 40% off the purchase of a Hussle Monthly+ pass. 33% off a Hussle Monthly+ pass is available to employees of AXA Health healthcare clients not covered by a company healthcare plan. They must provide proof of employer. Members must be over 16 to redeem AXA Health discounts with Hussle. Read full terms and conditions at axahealth.co.uk/terms/gym-discount.