The Small Business Guide to Private Health Insurance

Your business health insurance questions answered

Index

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 you can skip NHS waiting lists and receive eligible treatment quickly, at a time and place that's convenient for you. You'll usually be treated in the comfort of a private hospital, without having to worry about the bill at the end of the treatment, provided that it's covered by your plan.

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

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

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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 package1.

Recruitment

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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 benefits2. 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.

Reduced time out of work

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Reduced time out of work

Another benefit of small business health insurance is that it can help to reduce the amount of time that you and your team have to spend away from work due to ill health. Employee absence due to sickness can have a negative impact on any business, but small businesses may feel the impact more than a large company. In 2017, 131.2 million working days were lost due to ill health in the UK3.When you have a small team, every person plays an important role in the business. When one of your team is absent due to ill health, it can be difficult to find someone who can cover their workload for them while they're off. Small business health insurance can help get your team back to work quickly through prompt access to diagnosis and eligible treatment.

Flexible appointments

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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. You can also skip the NHS waiting lists for eligible treatment and be seen quickly by a specialist at a time and place that's convenient for you. At AXA PPP healthcare, our hospital network includes over 250 hospitals and over 400 scanning centres. Our members also have access to over 34,000 specialists and practitioners.

How might employees benefit from small business health insurance?

Peace of mind

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Peace of mind

As well as having benefits for the business, small business health insurance also has a number of benefits for the team. It can be a worrying time when ill health strikes, particularly when you're placed on a waiting list in order to receive treatment. Private healthcare cover can provide employees with peace of mind that, should they need to see a specialist, they can skip the NHS waiting lists and be seen quickly at a time and place that's convenient for them.

Convenient appointments

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Convenient appointments

Medical appointments can be difficult for employees to attend, particularly when they're at times and locations that are inconvenient to get to. 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 PPP healthcare, our small business health insurance also 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

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Treatment in a
private hospital

It also comes with the benefit that employees will receive eligible treatment in a private hospital. This means that they'll usually have their own private room, in most instances with an en-suite bathroom, TV, Wi-Fi that's usually free, tasty and nourishing food and free parking for visitors.

Access to 24/7
health information

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Access to 24/7
health information

At AXA PPP healthcare, 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.*

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 at a private hospital. 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 man insurance. Key man 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:
    1. You have received medication, advice or treatment for in the relevant period before the start of cover, or
    2. 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 PPP healthcare, 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.
  • Six-week option. Save up to 20% by choosing the six-week option. This option means your team will be treated on the NHS unless they need to wait more than six weeks for treatment. In this case, they would have their treatment privately.
  • Choose your excess. You could reduce your annual subscription by choosing an excess of £100, £250 or £500 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.

Tax implications

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 PPP healthcare for your small business health insurance?

At AXA PPP healthcare, our small business health insurance comes with a number of benefits for you, your team and your business.

Fast Track Appointments service

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Fast Track Appointments service

When you take out small business health insurance with us, you and your team will have access to our Fast Track Appointments Service. This means that if your GP recommends that you see a specialist, our Fast Track Appointments team will find you an appointment with a specialist at a time and place that suits you. Not only does this mean that you can skip the NHS waiting lists and be seen quickly, but it also means that you'll be able to get back to work quickly. And if you select an outpatient option, this appointment will be covered by your plan.

Online GP service

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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

Why choose AXA PPP
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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.

Expert help
available 24/7

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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*.

Employee Assistance Programme

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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

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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.

50% off annual
gym membership

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50% off annual
gym membership

When you take out small business health insurance with us, you and your whole team will get 50% off annual PureGym membership, even those not covered by your plan.

With over 200 sites around the country, PureGym offer convenient locations for your employees to exercise – whether that's before or after work, during the week or on the weekends, near the office or close to home.

And with over 50 free classes available every week, there's something to suit everyone. You'll find everything you need with over 2,000 personal trainers and state-of-the-art equipment. Plus there's the added convenience that you can book classes via the PureGym app.

*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 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 Treatment or Diagnostics Only 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. 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.

Cover options

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, especially if you’re on a long NHS waiting list to see a specialist. This option fast-tracks 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 will be arranged quickly, close to work or home. 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.
  • Travel Cover option. If your employees travel for business or pleasure, this option covers them for emergency medical treatment should the worst happen when they’re abroad. It also includes a range of travel-related benefits.
  • Dentist and Optician Cashback. Help your employees look after their teeth and eyesight with cashback towards dentists’ fees, glasses, contact lenses and eye tests.

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 work?

The diagram below briefly explains how the claims process usually works:

1

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.

2

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.

3

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 we can offer you.
  • How much your subscription should be.
  • How to cover any existing medical conditions you may have.

AXA PPP healthcare small business health insurance

Get a quote

Request a callback

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.

Sources and references

1Cover Magazine, 2018
2Canada Life Group
3Office for National Statistics, 2018